[Pain: clinical picture and objective criteria of therapy adequacy]. / Klinika boli: ob''ektivnye kriterii adekvatnosti terapii.

The paper is dedicated to electroencephalographic monitoring in the therapy and rehabilitation of patients with acute radicular pain syndromes of the disc etiology. Spontaneous electromyograms (EMG) of the shin muscles in healthy and affected legs and stimulation electroneurograms were registered in 52 patients; the readings were subsequently processed on the basis of Fourier analysis for the 4-sec maximal muscle contraction. The studies made it possible to detect the degree of destructive changes in the neuromotor apparatus and to monitor its functional recovery in pharmacotherapy, central and peripheral blocks, artificial correction of movements and in acupuncture.

[Electrophysiological approaches to pain evaluation in clinical practice]. / Elektrofiziologicheskie vozmozhnosti otsenki boli v klinike.

The basic principles of instrumental estimation acute and chronic pain syndrome are presented. Electromyography and restoration of H-reflex permit to estimate the pain and carry out dynamic control during therapeutic procedures for vertebrogenic pain syndrome. The methods mentioned are the components of complex approach to diagnosis of pain syndrome.

[Anesthesiologist and chronic pain]. / Anesteziolog i khronicheskaia bol'.

Effective therapy of chronic frequently recurring pain is a complex important problem from practical medical, social, and economic viewpoints. Organization of specialized "pain clinics" and pain control centers is discussed. These institutions will take care of patients with chronic pain syndromes. The role of anesthesiologists and reanimatologists at such clinics is analyzed. Experience gained at department of therapy of painful syndromes at the Russian Center of Surgery of the Russian Academy of Medical Sciences and the Integrative Medicine Center attached to it is reviewed. The authors offer recommendations on the use of traditional and nontraditional methods of pain relief. New highly effective integrative diagnostic methods (computer pulsometry) and therapies (resonance electropuncture analgesia and therapy) are used in various pain syndromes, including chronic frequently relapsing, which are usually resistant to common methods. Integrative methods of clinical reflex therapy create conditions for replacing traumatic surgical and radiological methods used in the treatment of critically ill patients by methods of integrative medicine.

[Our general chronic pain (centers for treatment chronic pain: therapeutic and organizational work principles)]. / Nasha obshchaia khronicheskaia bol' (K voprosu o Tsentrakh do lecheniiu khronicheskoi boli: lechebnye i organizatsionnye printsipy raboty).

Management of chronic pain is now not only medical but a very important social and economic problem. The approaches to its management in specialized pain control centers are discussed basing on the 20-year experience of the first such center in Russia: pain control clinic with therapeutic and diagnostic center "Integrative Medicine" at Research Center of Surgery. The problems of personnel for such pain control centers, cost-effect issues, diagnostic and therapeutic methods including an advanced technique, resonance electropuncture analgesia and therapy, are reviewed.

[The content of beta-endorphin, met-enkephalin and ACTH in the blood plasma during electric and drug anesthesia]. / Soderzhanie beta-éndorfina, meténkefalina i AKTG v plazme krovi pri élektromedikamentoznoi anestezii.

Beta-endorphin, metenkephaline, and ACTH were radioimmunoassayed in the peripheral blood plasma of 4 groups of patients subjected to microsurgery by different techniques. In 3 groups electropulsed exposure of the CNS was a component of general combined ataralgesia. In group 1 (13 patients) two Lenar devices were employed, in group 2 (5 patients) Skat-202 device, in group 3 (7 patients) Elean device. Group 4 (17 patients) were controls administered drugs according to the same protocols as in the rest three groups. Anesthesia was considered adequate in all the groups. The hypoalgesic effect of electroexposure was the most expressed in group 1: fentanyl was not injected in 53% cases, and in 47% its dose, 0.74 microgram/kg/h, was 2.25 times lower than in controls (1.58 micrograms/kg/hm p < 0.05); the drug doses in groups 2 and 3 (0.82 and 0.8 microgram/kg/h) were 1.9 and 2 times lower than in controls, respectively, p < 0.05. The levels of ACTH and opioid peptides were measured at 6 stages: 1) several days before surgery; 2) after premedication, 10-15 min after the patient was brought into the operation room; 3) before discontinuing nitrogen oxide; 4) after discontinuing nitrogen oxide; 5) when the patient regained consciousness after the end of surgery; and 6) after extubation of the trachea. During surgery under electromedicamentous anesthesia the level of ACTH in the plasma was the same as initially or comparable to the level of this hormone at the same stages in the control group. The content of opioid peptides changed at stressogenic stages of anesthesia and surgery. In patients administered drug anesthesia beta-endorphin levels were shifted, in those operated on under electromedicamentous anesthesia the metenkephaline compound of the opiate system was altered. Activation of various components of endogenous opiate system in electromedicamentous and drug anesthesia may be due to differences in the mechanisms of this types of anesthesia at the given level of the antinociceptive system of the organism. No stable reaction of endorphin level on the electroexposure could be detected. There was no evident relationship between changes in the levels of opioid peptides and the decrease of fentanyl consumption. Besides, it is possible that the analgesic effect of electroexposure is mediated not only by the opioid, but by other mechanisms of endogenous antinociceptive system as well.

[Acupuncture analgesia and analgesic transcutaneous electroneurostimulation in the early postoperative period]. / Igloanalgeziia i protivobolevaia chreskozhnaia élektroneirostimuliatsiia v rannem posleoperatsionnom periode.

Efficacies of two methods of nondrug analgesia: acupuncture (1000 cases) and antipain transcutaneous electroneurostimulation (91 cases), as well as of narcotic analgesics omnopon and promedol (229 cases) were compared in the immediate and early postoperative period. In 229 cases acupuncture was used for the treatment of other functional complications of the postoperative period. The efficacies of the methods in question were assessed by formalized verbal estimation scales. Narcotic analgesics provided adequate analgesia in 75 to 79% of patients, electrostimulation in 61 to 64%, acupuncture in 50% of patients. Acupuncture, though less effective than narcotic analgesics, helped arrest or noticeably alleviate the severity of such postoperative complications as reflex retention of the urine, impairment of hte drainage function of the bronchi, intestinal paresis, bronchial asthma, vomiting, nausea, pain or itching in the stoma, chill, hyperthermia in 43 to 81% of cases. The authors come to a conclusion on the desirability of an integrative approach (combined use of drugs and nondrug methods of analgesia) in the management of postoperative pain.

[Central electroanalgesia as a component of combined anesthesia in reconstructive microsurgery]. / Tsentral'naia élektroanalgeziia kak komponent kombinirovannoi anestezii pri rekonstruktivnykh operatsiiakh s mikrokhirurgicheskoi tekhnikoi.

Efficacy of central analgesia and adequacy of anesthesiologic protection in operations making use of microsurgical techniques were analyzed by double blind method using the criterion 'requirement in narcotics' in 88 specially selected patients divided into 4 groups. Group 1 (n = 24) were patients operated on under electro-medicamentous anesthesia after Kastrubin-Kordyukov; group 2 (n = 21) were operated on under electro-medicamentous anesthesia after Limoges' technique modified by M.I. Kuzin et al.; group 3 consisted of 14 patients operated on under combined anesthesia based on NLA agents and simultaneous simulation of transcerebral electropulse exposure (placebo group); and group 4 (n = 29) were patients operated on under combined NLA anesthesia (controls). To assess the function of systems of adaptation to surgical trauma blood plasma levels of ACTH and cyclic nucleotides were measured at 7 stages of anesthesia.

[The choice of anesthesia for endoscopic interventions in the upper digestive tract]. / K vyboru obezbolivaniia pri éndoskopicheskikh vmeshatel'stvakh na verkhnem otdele pishchevaritel'nogo trakta.

The efficacy of local anesthesia during upper abdominal endoscopy was compared to that of local anesthesia in combination with moradol. Local anesthesia of the throat combined with intramuscular moradol (0.04 mg/kg) helps retain psychoemotional indifference and stable hemodynamic and autonomous system parameters in such traumatic moments of the endoscopy as irritation and dilatation, which cannot be said of patients who were subject to such interventions under local anesthesia alone.

[Regional anesthesia by conduction anesthesia and reflexotherapy technics in the acute readaptation period following antiorthostatic hypokinesia]. / Regionarnoe obezvolivanie metodami provodnikovoi anestezii i refleksoterapii v ostrom readaptsionnom periode posle antiortostaticheskoi gipokinezii.

After 7-day head-down tilt at --8 degrees six healthy male test subjects were exposed to leg anesthesia achieved by peridural anesthesia (3 subjects) and electroauriculoacuanalgesia (3 subjects), with circulation parameters being monitored. The anesthetic effect was not accompanied by significant changes in hemodynamics or homeostasis.